In this retrospective, single-centre study, Clemente-Gutierrez et al. explored the often under-appreciated adrenal manifestations found in multiple endocrine neoplasia type 1 (MEN1), which extend beyond the condition’s classical trio of parathyroid, pancreas and pituitary glands.

They discovered that 23.3% of 382 MEN1 patients exhibited adrenal lesions. The findings reveal a nuanced picture: among 101 measurable nodular lesions (average size 17.5mm), 78.2% were monitored without immediate intervention. Notably, 35.4% of these lesions showed growth, prompting surgery in four cases, due to alarming radiological characteristics. This resulted in two diagnoses of neoplasms with uncertain malignant potential, one diffuse adrenal enlargement, and one adrenocortical carcinoma.

Functional assessment conducted in 38 patients was positive in 6 individuals, with the majority undergoing surgery. The presence of phaeochromocytoma (n=2), hyperandrogenism due to adrenocortical carcinoma (n =1), and adrenocorticotrophic hormone-dependent hypercortisolism with diffuse adrenal enlargement (n =2) underscores the diversity and potential severity of adrenal involvement in MEN1.

Overall, this study suggests baseline hormonal evaluation for lesions >1cm, emphasising vigilance for malignancy in lesions exhibiting significant growth or suspicious radiological features, and the critical need for comprehensive screening and tailored management in patients with MEN1.

Read the full article in Endocrine-Related Cancer 31 e230162 https://doi.org/10.1530/ERC-23-0162